The following is a summary of “Epinephrine administration in adults with out-of-hospital cardiac arrest: A comparison between intraosseous and intravenous route,” published in the May 2023 issue of Emergency Medicine by Yang, et al.

For a retrospective study, researchers sought to compare the success rates of establishing the access route, rates of epinephrine administration, and time-to-epinephrine between adult patients with out-of-hospital cardiac arrest (OHCA) who received intraosseous (IO) access and those who received intravenous (IV) access by paramedics in the prehospital setting.

Data for IV access were collected from January 1, 2020, to December 31, 2020, while data for IO access were collected from January 1, 2021, to March 10, 2021. The data were obtained from the San-Min station of the Taoyuan Fire Department. The study included adult patients with OHCA who underwent on-scene resuscitation attempts and had either IV or IO access established by paramedics. Exclusion criteria comprised missing data, return of spontaneous circulation before vascular access, cardiac arrest en route to the hospital, patients not resuscitated, and unidentified OHCA cases reported by the dispatcher. The success rates of route establishment (successes/attempts), administration rates of epinephrine (epinephrine administered per case/enrolled OHCAs), and odds ratios of IV versus IO on epinephrine administration were evaluated. Nonparametric Mann-Whitney rank sum tests and Fisher’s exact tests were used for statistical analysis of continuous and categorical variables, respectively. 

Sparse data analysis was conducted using the Firth logistic regression method. Additionally, factors associated with epinephrine administration and vascular access were analyzed. Time-to-epinephrine (time from paramedic arrival to epinephrine injection) was reviewed and calculated by two independent observers, and the Kaplan-Meier method was used to compare the two access routes.

A total of 112 adult patients (71 men, 41 women) with an average age of 67 years were included in the analysis. Of these, 90 cases had IV access, while 22 had IO access. The comparison between the groups revealed significantly higher median success rates of route establishment (100% vs. 33%, P < 0.001) and epinephrine administration rates (100% vs. 52%, P < 0.001) in the IO access group. The adjusted odds ratio of IO versus IV for epinephrine administration was 32.445 (95% CI: 1.844–570.861). In addition, the cumulative time-event analysis using the Kaplan-Meier method demonstrated a significantly shorter time-to-epinephrine in the IO access group (P < 0.001).

The use of IO access in prehospital resuscitation of adult patients with OHCA was associated with higher success rates of route establishment, higher rates of epinephrine administration, and shorter time-to-epinephrine compared to IV access.

Source: sciencedirect.com/science/article/abs/pii/S0735675723000682